Standing, light walking benefit patients along several metrics

Action Points

Breaking up sitting with standing and light-intensity walking improved 24-hour glucose levels and insulin sensitivity in type 2 diabetes to a greater extent than did structured exercise, in a study of 19 patients.

Note that at least 150 minutes of moderate-to-vigorous exercise each week has long been considered an important part of preventing and treating type 2 diabetes, although at least 90% of the population probably does not meet this threshold.

Periodically standing and walking around is sufficient to promote better blood sugar control, lower 24-hour glucose levels, and improve insulin sensitivity in patients with type 2 diabetes, according to a study online in Diabetologia.

"Our results suggest that for people with type 2 diabetes, light-intensity activities (light walking and standing) can be an alternative to exercise to improve glucose regulation," the lead study author, Bernard Duvivier, MD, of Maastricht University in the Netherlands, told MedPage Today. "For people with type 2 diabetes who don't like to exercise, light activities can be a good alternative."

At least 150 minutes of moderate-to-vigorous exercise each week has long been considered an important part of preventing and treating type 2 diabetes. Nevertheless, 90% of the population does not meet this threshold, and that percentage is probably higher, Duvivier and colleagues state, in those who have type 2 diabetes, for whom muscle weakness and peripheral neuropathy can impede exercise.

In the randomized crossover study, 19 people with type 2 diabetics (13 men and six women, 63 ± 9 years old) who were not using insulin followed three different activity regimens for 4 days each:

"Sit Less" (17,502 steps per day with 4.7 hours of standing and light walking).

Participants had a mean body mass index of 30.5, with a median type 2 diabetes duration of 6 years. Individuals also had a mean HbA1c of 6.7% and mean fasting plasma glucose of 141.8 mg/dL during screening. Fourteen participants used glucose-lowering drugs (metformin, n=14; sulfonylurea, n=7; sitagliptin, n=2), and 13 used lipid-lowering drugs (statins, n=12; ezetimibe, n=2). Meals were standardized in all cases.

The researchers selected the number of participants based on the results of a 2010 study analyzing differences between sedentary, low-intensity exercise, and high-intensity exercise in patients with type 2 diabetes.

In the Maastricht University study, physical activity and glucose levels were respectively assessed with accelerometry and glucose monitors. The incremental area under the curve (iAUC) for 24-hour glucose and insulin resistance (HOMA2-IR) were respectively assessed on days 4 and 5.

In the Sit Less regimen, replacing some daily sitting time with standing and light walking significantly reduced 24-hour glucose levels (mean 132 mg/dL with Sit Less versus 138 mg/dL with sitting; P=0.014). Sit Less also reduced glucose levels by approximately 36% compared with the sitting activity program (P=0.002).

Sit Less also significantly (P=0.001) reduced fasting insulin levels to 551 ng/L compared with the same levels in the higher-intensity exercise program and the sitting regimen (592 vs 626 ng/L, respectively; P=0.117).

The Sit Less intervention may, in some ways, be even more effective than higher-intensity exercise regimens and is a "potent" way of treating type 2 diabetes, the researchers said.

"Since no significant differences were observed in mean glucose values after Sit Less as compared with Exercise, this finding suggests that Sit Less, but not Exercise, improved insulin sensitivity. The effect of breaking up sitting time on insulin resistance was more pronounced than that of structured exercise. Additionally, the more abrupt and prominent reduction in blood glucose in the structured exercise intervention is proposed to increase the risk of hypoglycemia."

Moving forward, Duvivier suggested additional studies to "investigate the feasibility of replacing sitting time with light activities on the longer-term" and "the underlying cellular mechanisms explaining our results."

The study was sponsored by Maastricht University Medical Centre and partially funded by a Kootstra Talent Fellowship from the university's Centre for Research Innovation, Support, and Policy, as well as by Novo Nordisk BV and the Netherlands Cardiovascular Research Initiative of the Dutch Heart Foundation.

Duvivier and coauthors reported having no conflicts of interest related to the study.

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